SURGICAL GENERALITIES. This has been largely a plea for you to look beyond the medical horizon that you may note the appearance of a non-medical case and when you do, please call a surgeon immediately and you may save the life of your patient. Use Homoeopathy as medical treatment, but never as a substitute for surgery.

Your esteemed chairman asked me to write a paper for his Bureau, one that is surgical in character.

Perhaps at first thought one might wonder why a homoeopath should ask for such a paper or why a homoeopath should be interested in surgery. I think the answer is brief, terse and definite. Perhaps a homoeopath is not interested in the technique or mechanics of surgery but he very definitely is interested in surgical diagnosis.

The question that must be decided in approaching a case is, firstly, is it medical? and secondly, is it surgical? If medical, then certainly homoeopathic treatment is per excellence; if surgical, then a surgeon should be called at once and not a “dernier resort.” In many instances the surgeon is unfortunately called after the chance of recovery has been sacrificed any ill- advised medical treatment.

Page: 140.

Your writer has chosen to discuss several surgical generalities that confront the average practitioner.

First, that innocent little lump in the breast. You will think of the remedies, Conium, Phytolacca, Bellis, etc., but may I suggest that caution be used; examine the entire breast before you consider a remedy. Can you see farther under the skin than the patient, can you definitely say that the lump is innocent or malignant? This is an exceedingly difficult question to answer and the patients life may depend upon the accuracy of your answer. Prescribe accurately and give the patient about four weeks. If there is no change in the lump, then it should be removed and a biopsy performed. There is, in the opinion of the writer, no other approach.

Secondly, the thyroid. Here is a field that is very distinctly homoeopathic in its nature. I refer particularly to the hyperthyroid cases. The patient should be free from worry, have absolute rest, and proper medication. Here again, permit me to say that the case should not be permitted to run until permanent heart damage has followed. Economics has to enter into these cases also. Take the housewife who cannot stay in bed with complete rest and freedom from worry indefinitely, which these cases need for recovery; therefore, the need for careful evaluation of the case is most important. If surgery will meet the exigencies of the case and the probable result will be favorable, then surgery should be resorted to. Permit me to make a reference to our distinguished chairman who can give an answer to this question.

Thirdly, the appendix. Here we have a very define and extremely debatable field. Diagnosis of an acute appendix, in its various forms, is not always easy. In the young male, the question of mesenteric adenitis enters the field as well as intestinal intussusception. The young female presents the question of a rupture of a graafian follicle. The writer very distinctly believes that many of these cases of appendiceal irritation are handle by homoeopathic prescribing very successfully, but in cases with acute onset we must be very careful in the treatment.

Here one may be dealing with a fulminating type of appendix that will proceed from the beginning to rupture in twelve to 24 hours. This is particularly true of the young and aged. Surgery in the quiescent stage or before the onset of peritonitis is a comparatively simple procedure, but after the onset of peritonitis the case assumes an extremely grave aspect.

Fourthly, the prostate. Here is a field where the homoeopathic practitioner, in my opinion, is apt to err definitely. Malignancy of the prostate begins in a comparatively innocent growth, very difficult to detect. At a homoeopathic meeting in Louisville some years ago your writer was approached by a well-known man, who described his symptoms to me and stated that he had been treating himself. He was an experienced prescriber and had made the grave error of treating himself for a malignancy of his prostate until he was past the stage of any surgical relief. These cases require very cautious handling.

Fifthly, melanoma. The innocent little pigmented moles that one finds over the body require careful management and should either be left alone or receive a rather wide excision which can be done under local anesthesia. If one waits until these innocent moles spring into activity, the chance for recovery is then gone for it has by this time probably already widely metastasized. If surgical treatment does not come early in these cases, it is not worth while, and the patient has lost his chance for recovery.

Sixthly. The cervix. This organ, along with the breast which was dealt with above, are the two most common causes of malignant deaths in females. The cervix of the patient should be inspected regularly. If there is any erosion, it should be painted with Lugols Solution to determine if it gives the characteristic reaction that follows the use of iodine; also the discharge should be examined by the Papanicolaou test. The use of the iodine can be resorted to in the office. The discharge can be sent t any center for examination by the Papanicolaou method.

Franklin H. Cookinham